LCD and Policy Article Revisions Summary for January 16, 2025 - JD DME

Joint DME MAC Publication
Posted January 16, 2025

Outlined below are the principal changes to the DME MAC Local Coverage Determinations (LCDs) and Policy Articles (PAs) that have been revised and posted. The policies included are Ankle-Foot/Knee-Ankle-Foot Orthosis, Immunosuppressive Drugs, Knee Orthoses, and Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics). Please review the entire LCDs and related PAs for complete information.

Ankle-Foot/Knee-Ankle-Foot Orthosis

LCD

Revision Effective Date: 01/01/2025
COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:
Added: HCPCS codes E1813, E1814, E1822, and E1823 to the HCPCS codes noted as concentric adjustable torsion style mechanisms used for the treatment of contractures, regardless of any co-existing condition(s)

01/16/2025: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-discretionary updates per CMS HCPCS coding determinations.

PA

Revision Effective Date: 01/01/2025
CODING GUIDELINES:
Revised: Long descriptions for HCPCS codes E1810 and E1815
Added: HCPCS codes E1813 and E1814 to the HCPCS codes noted as codes for durable medical equipment that are used when coding claims for devices that contain a concentric adjustable torsion style mechanism in the knee joint for any condition other than an assistive function to joint extension motion
Added: HCPCS codes E1822 and E1823 to the HCPCS codes noted as codes for durable medical equipment that are used when coding claims for devices that contain a concentric adjustable torsion style mechanism in the ankle joint for any condition other than an assistive function to joint plantar- or dorsiflexion motion

01/16/2025: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.

Immunosuppressive Drugs

LCD

Revision Effective Date: 01/01/2025
HCPCS CODES:
Added: HCPCS code J7514

01/16/2025: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-discretionary updates per CMS HCPCS coding determinations.

Knee Orthoses

LCD

Revision Effective Date: 01/01/2025
COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:
Added: "regardless of any co-existing condition(s)" and codes "E1813 and/or E1814" to the description of concentric adjustable torsion style mechanisms used for the treatment of contractures

01/16/2025: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-discretionary updates per CMS HCPCS coding determinations.

PA

Revision Effective Date: 01/01/2025
CODING GUIDELINES:
Revised: Long descriptor for HCPCS code E1810
Added: "E1813 (DYNAMIC ADJUSTABLE KNEE EXTENSION ONLY DEVICE, INCLUDES SOFT INTERFACE MATERIAL), or E1814 (DYNAMIC ADJUSTABLE KNEE FLEXION ONLY DEVICE, INCLUDES SOFT INTERFACE MATERIAL)" to language for all claims for devices that contain a concentric adjustable torsion mechanism in the knee joint for any condition other than an assistive function to joint extension motion

01/16/2025: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.

Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics)

LCD

Revision Effective Date: 01/01/2025
HCPCS CODES:
Added: HCPCS code Q0155

01/16/2025: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-discretionary updates per CMS HCPCS coding determinations.

PA

Revision Effective Date: 01/01/2025
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Added: Q0155 to the list of oral antiemetic drugs covered when criteria met
CODING GUIDELINES:
Added: Q0155 to the list of oral antiemetic drugs that may be billed
Added: Q0155 to the instructions regarding the quantity of drugs billed must not exceed the 24 or 48 hours of therapy indicated

01/16/2025: At this time the 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.

Note: The information contained in this article is only a summary of revisions to the LCDs and/or PAs. For complete information on any topic, you must review the LCDs and/or PAs.

With the update(s) listed above, Noridian would like to remind users how to find the policy that was previously effective. When billing, the supplier should follow guidance that was effective on the date of service. The below steps can be followed to find all previous policies:

1. Open the currently effective policy on the Medical Coverage Database (MCD)
   1. Links to the MCD can be found on the Active LCDs page on the Noridian website
      1. There is a link at the top of the Active LCD page that goes to a full list of the LCDs or PAs, depending on which link is selected OR
      2. There are direct links to all LCDs under the ‘LCD ID number and Effective Date’ column
2. Scroll down to the bottom of the policy
3. Find the section labeled Public Version(s)
4. Look for the link to the policy that was effective on the dates of service in question.
5. Click on hyperlink to go to the policy.